Current drug therapy for multiple myeloma

Recent years have witnessed tremendous advances in the molecular pathogenes is and management of multiple myeloma, Standard chemotherapy (melphalan and prednisone: MP) has been the mainstay of treatment of multiple myeloma for about 3 decades, However, it is no longer considered the 'gold standard', particularly for those patients who will subsequently undergo intensive che motherapy with autologous or allogeneic peripheral blood stem cell (PBSC) o r bone marrow transplantation (BMT), or for patients with refractory myelom a, A variety of induction combination chemotherapy regimens have been devel oped, some of which have demonstrated an improved response rate and duratio n and a superior 5-year survival rate when compared with standard chemother apy, The early use of high dose chemotherapy with autologous PBSC support o r BMT has significantly increased the complete remission rate, and has prol onged event-free survival and overall survival. Allogeneic bone marrow or P BSC transplantation may bt:a good option for selected patients with poor pr ognostic features. The role of interferon-alpha in multiple myeloma is still inconclusive desp ite many years of clinical evaluation. The clinical application of chemosen sitising agents that can inhibit P-glycoprotoin (P-gp) expression and funct ion, and particularly the development of more potent P-gp modulators such a s valspodar (PSC 833) and elacridar (GF1209 18) has mode it possible to rev erse multidrug resistance in some refractory patients and to enhance the ef ficacy of che motherapeutic agents. Immunotherapeutic approaches to purging of autologous bone marrow or PB SCI or as adjuvant therapy for minimal res idual disease, show great promise. Finally. a number of new therapies speci fically designed to treat many of the complications of multiple myeloma are improving clinical outcomes and quality of life for these patients.